Provider Demographics
NPI:1144352618
Name:LEWIS, MARLA ELAINA (MA, LLPC, TLLP)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:ELAINA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LLPC, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 LESLEE CREST DR
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3724
Mailing Address - Country:US
Mailing Address - Phone:248-788-1739
Mailing Address - Fax:248-335-1732
Practice Address - Street 1:43902 WOODWARD AVE
Practice Address - Street 2:#110
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5011
Practice Address - Country:US
Practice Address - Phone:248-338-1700
Practice Address - Fax:248-335-1732
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009100101YM0800X
MI6301013059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical